Reconsideration of the cut-off value of angiotensin-converting enzyme for screening of sarcoidosis in Japanese patients.

BACKGROUND: In clinical practice, we frequently experience patients with sarcoidosis who show relatively high but normal values of angiotensin-converting enzyme (ACE). The objective of this study was to reconsider the cut-off value of ACE. METHODS: We studied 79 Japanese patients who were diagnosed as having sarcoidosis at our hospital. We excluded patients who had taken steroids or ACE inhibitors and patients with renal impairment. We respectively evaluated ACE values and performed receiver operating characteristic (ROC) analysis from a comparison with data for 299 normal Japanese subjects who showed ACE values in the current Japanese standard normal range (7.0-25.0IU/L). RESULTS: Patients with sarcoidosis had higher ACE values than those in normal subjects (ACE: 20.3IU/L [IQR, 16.0-24.4] vs. 15.4IU/L [IQR, 12.8-18.5]; p<0.001). However, 62 patients (78.5%) had normal ACE levels (cut-off value <25.0IU/L), and the sensitivity of ACE level for detecting sarcoidosis was only 21.5%. From ROC analysis, a cut-off value of 17.7IU/L (AUC: 0.727, 95% CI: 0.660-0.794, p<0.001) was the best cut-off value for detecting sarcoidosis and sensitivity increased to 67.0%. CONCLUSIONS: The possibility of sarcoidosis cannot be ruled out by using the current Japanese standard value even in patients who have normal ACE levels. Careful interpretation of this biomarker is needed.

Usefulness of Screening for Abdominal Aortic Aneurysm During Transthoracic Echocardiography in Women ≥50 Years of Age.

Usefulness of screening for abdominal aortic aneurysm (AAA) during transthoracic echocardiography (TTE) in women is uncertain. The aim of the present study was to clarify the clinical usefulness of screening for AAA during TTE and to identify important TTE indices associated with AAA in women in a routine clinical setting. We prospectively studied 1,495 women (≥50 years) referred for TTE. AAA was defined as ≥30 mm in size. The additional screening time for AAA was <1 minute. The abdominal aorta was visualized in 95.1 % (1,422 of 1,495) using the same TTE probe. AAA was identified in 1.9% (27 of 1422). The aortic root size was larger in patients with AAA than those without (33.3 ± 3.2 vs 30.5 ± 3.4 mm, p < 0.001). The aortic root size had a correlation with abdominal aortic size (r = 0.22, p < 0.001). The aortic root size of ≥30.3 mm was predictive of AAA (area under the curve = 0.74, p < 0.001) and all patients with AAA had the aortic root size of ≥28.0 mm. Multiple logistic regression analysis revealed that the aortic root size (Odds ratio 1.17, p = 0.007) was a most independent TTE index of AAA. In conclusion, the visibility of the abdominal aorta using TTE probe was excellent. When the aortic root size is ≥28.0 mm during TTE in women ≥50 years of age, screening for AAA should be carried out.

Differentiation of infiltrative cardiomyopathy from hypertrophic cardiomyopathy using high-sensitivity cardiac troponin T: a case-control study.

BACKGROUND: Because infiltrative cardiomyopathy and hypertrophic cardiomyopathy (HCM) share clinical and hemodynamic features of left ventricular (LV) hypertrophy and abnormal diastolic function, it is often difficult to distinguish these entities. METHODS: We investigated the potential role of high-sensitivity cardiac troponin T (hs-cTnT) for differentiation of infiltrative cardiomyopathy from HCM. RESULTS: The study group consisted of 46 consecutive patients with infiltrative cardiomyopathies or HCM in whom sarcomere protein gene mutations were identified at Kochi Medical School Hospital; of these, there were 11 patients with infiltrative cardiomyopathy (cardiac amyloidosis in 8 patients and Fabry disease in 3 patients) and 35 HCM patients. Serum hs-cTnT level was significantly higher in patients who had infiltrative cardiomyopathy than in those who had HCM (0.083 ± 0.057 ng/ml versus 0.027 ± 0.034 ng/ml, p < 0.001), whereas brain natriuretic peptide levels did not differ between the two groups. In two age-matched the 2 cohorts (patients evaluated at > 40 years at age), hs-cTnT level, maximum LV wall thickness, posterior wall thickness, peak early (E) transmitral filling velocity, peak early diastolic (Ea) velocity of tissue Doppler imaging at the lateral corner and E/Ea ratios at both the septal and lateral corners were significantly different between the two groups. As for diagnostic accuracy to differentiate the two groups by using receiver operating characteristic analysis, hs-cTnT was the highest value of area under the curve (0.939) and E/Ea (lateral) was second highest value (0.914). CONCLUSIONS: Serum hs-cTnT is a helpful diagnostic indicator for accurate differentiation between infiltrative cardiomyopathy and HCM.

Serum level of soluble CD30 correlates with the aggressiveness of adult T-cell leukemia/lymphoma.

Adult T-cell leukemia/lymphoma (ATL) is a highly aggressive disease with poor prognosis. CD30(+) cells are frequently observed in lymph node cells and peripheral blood mononuclear cells of ATL patients. In order to elicit the role of CD30(+) cells in ATL development, we investigated expression of the membrane type of CD30 (mCD30) and the soluble form of CD30 (sCD30) on ATL cells. Both mCD30 and sCD30 are expressed on various numbers of ATL cells in vivo as well as cell lines such as MT-2, L540 and Karpas 299. The level of serum sCD30 in each clinical stage showed an elevated level in patients with acute type (mean +/- standard error; 545.2 +/- 18.6 U/mL) rather than with lymphoma type ATL (327.62 +/- 94.85 U/mL). In four patients whose sera were stored and examined longitudinally, the levels decreased following the response to chemotherapy but not in patients with chemotherapy resistance. Thus, our results imply that sCD30 levels may be another useful marker for the activity and aggressiveness of ATL.